PDF
Word
Form SFN614 Physician Certification for Medically Necessary Hysterectomy and Member Acknowledgment of Sterility - North Dakota
What Is Form SFN614?
This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is SFN614?A: SFN614 is a form used in North Dakota for physician certification for a medically necessary hysterectomy and member acknowledgment of sterility.
Q: Who uses SFN614?A: The form is used by physicians and patients in North Dakota.
Q: What is the purpose of SFN614?A: The purpose of SFN614 is to document the physician's certification of a medically necessary hysterectomy and the patient's acknowledgment of sterility.
Q: What information is included in SFN614?A: The form includes information about the patient, physician certification for the procedure, and the patient's acknowledgment of sterilization.
Q: Is SFN614 required for all hysterectomies in North Dakota?A: No, SFN614 is only required for medically necessary hysterectomies where sterilization is intended.
Q: What should I do with SFN614 after filling it out?A: Once filled out, SFN614 should be submitted to the patient's healthcare provider for processing.
Form Details:
- Released on October 1, 2019;
- The latest edition provided by the North Dakota Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form SFN614 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
Download Form SFN614 Physician Certification for Medically Necessary Hysterectomy and Member Acknowledgment of Sterility - North Dakota
1
2
